As pill turns 50, family planning too costly for many

WASHINGTON — On May 9, 1960, the Food and Drug Administration approved oral contraceptives, which changed the lives of generations of women, giving them the choice of when and how to have children.

Five decades later, however, millions of the country's poorest women aren't sharing in the empowerment.

Nearly 59 percent of women who are in need of subsidized family planning nationwide aren't receiving care, according to data from the Guttmacher Institute, a nonprofit organization that works to advance reproductive health, including abortion rights.

"People think you can just go to the corner drugstore and have your needs taken care of," Guttmacher public policy associate Elizabeth Nash said. "Unfortunately, there are lots and lots of men and women who need subsidized care in this respect."

Guttmacher's most recent study was released in 2006, before unemployment skyrocketed and the country sank into a recession. At the time, the national unemployment rate was 4.7 percent, 5 percentage points lower than it is today. Even then, however, 17.5 million women of reproductive age needed assistance paying for contraception, according to Guttmacher.

"We can only predict that new data is going to be worse," said Clare Coleman, the chief executive officer of the National Family Planning and Reproductive Health Association, which represents about 90 percent of federally funded family-planning clinics.

As people across the country are losing jobs — and their health insurance — many more women are either turning to Medicaid or engaging in risky behavior.

"Skipping pills is a big phenomenon," Coleman said. "As the recession gets bigger, more people are falling into low income and staying there longer. They may have thought, 'I will be OK because I have six months of pills.' Then they get to the end and don't have a job. They can't afford to get the checkup. Then they start going to less effective methods."

Individual women aren't the only ones who are struggling to find room in their budgets for birth control. States are, too.

Family planning funding across the country comprises a patchwork of different funding types that can be complicated, confusing and different from state to state. The state-based options range from private-public partnerships, with providers such as Planned Parenthood, to community health centers and private physicians. However, the most common source of funding for subsidized and no-cost birth control was Medicaid, according to Guttmacher.

One of the most successful family-planning programs in the country is in one of the most financially unstable states. For the past 11 years, California's Family PACT plan has been providing free family-planning services to women who earn less than 200 percent of the national poverty level, which is about $22,000 for a single woman, according to the U.S. census poverty threshold.

"We're serving about 1.8 million Californians today," said Laurie Weaver, the chief of the California health department's Office of Family Planning. "The cost of the program benefit is about $311 per year per client, but when we did our last survey in 2002, we were saving the state and federal government nearly a billion dollars every two years."

The savings are realized by preventing pregnancies in women who'd need financial assistance with prenatal, birthing and postnatal care and, in some instances, treatment for pregnancy complications, Weaver said.

California's system is intended to reduce or eliminate as many barriers to accessing assistance as possible. Not only is its income threshold one of the highest in the country, women are enrolled and eligible for services on the same day. They can go to walk-in clinics and walk out with their contraceptives.

Still, Guttmacher estimates that only 55 percent of the women who need services in California are receiving them.

That number is good compared with some states, however. In North Carolina, only 35 percent of the women who need help in obtaining birth control receive it.

"The challenge around rural areas is funding and confidentiality," said Paige Johnson, a spokeswoman for Planned Parenthood of Central North Carolina. "You're likely to know someone who is working in your health department. For many people, the fear of being seen or known will prevent them from going to get services."

North Carolina, like California, is one of the 28 states that have waivers that allow them to use federal Medicaid funds to offset the cost of family planning. However, for the past 15 years the state has had an abstinence-only sex-education system.

According to Johnson, the abstinence-only plan wasn't working. Johnson and a bipartisan group of legislators and advocates recently helped pass a comprehensive sex-education plan that will go into effect this fall.

"It took us two years to really help legislators understand that you start with abstinence and you continue with providing medically accurate information," she said.

Untangling family-planning preventive measures from discussions of abortion was a key step, Johnson said. If the two issues become linked and abortion fights grab headlines, family planning gets lost in the outcry.

In the final health care bill that Congress passed, the two issues ultimately were divided, and millions of women soon will have access to the help they need. The Medicaid expansion included in the law will do away with the need for state waivers and patchwork funding systems. Low-income families will have access to the same family planning options across the country.

While the health care measure may not have had bipartisan support, federally funded family planning does.

"I think more and more Republicans are certainly coming around to saying that we can separate prevention and planning from abortion," said Kellie Ferguson, the executive director of the Republican Majority for Choice, an organization that supports reproductive rights. "Whether you're pro- or anti-choice, we all want to see the rate and need for abortion to go down."

(The Medill News Service is a Washington program of the Medill School of Journalism at Northwestern University.)